Rationale: Until now, no cohort studies have evaluated the relationship between high-risk human papillomavirus (HPV) infection and new-onset cardiovascular diseases (CVD).
Objective: We investigated an association between high-risk HPV infection and the development of CVD.
Methods and Results: We conducted a cohort study of 63,411 women aged 30 or older without CVD at baseline who underwent a high-risk HPV test and were followed annually or biennially from 2011 to 2016. CVD was ascertained through the linkage to the Health Insurance and Review Agency database. A Cox proportional hazards regression model was used to estimate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of incident CVD. The prevalence of high-risk HPV infection was 7.6%. During 261,598.9 person-years of follow-up, 1,122 cases of new-onset CVD were identified (incidence rate of 4.3 per 103 person-years). High-risk HPV infection was significantly associated with incident CVD. After adjustment for possible confounders, and high sensitivity C-reactive protein, a significant association between high-risk HPV infection and incident CVD was still observed, with a corresponding HR (95% CI) of 1.25 (1.03-1.52). This association was stronger among individuals with obesity and those with metabolic syndrome (MetS). Multivariable-adjusted HR (95% CI) for incident CVD comparing high-risk HPV-positive- to high-risk HPV-negative participants was 1.10 (0.87-1.39) in the non-obese, whereas corresponding HR (95% CI) was 1.73 (1.19-2.51) in those with obesity (P for interaction by obesity=0.002). Similarly, multivariable-adjusted HR (95% CI) for incident CVD comparing high-risk HPV-positive- to high-risk HPV-negative participants was 1.09 (0.87-1.36) in those without MetS and 1.99 (1.28-3.08) in those with MetS (P for interaction=0.05).
Conclusions: In this large cohort, high-risk HPV infection was significantly associated with an increased risk of developing CVD, especially in obese individuals and those with MetS, indicating that high-risk HPV might affect CVD risk with possible effect modification by obesity and MetS.
Key Words: cardiovascular diseases, cohort studies, incidence, obesity, risk factors